Ambulatory Surgical Facilities in Northeast Pennsylvania Collaborate with the Pennsylvania Patient Safety Authority to Reduce Day-of-Surgery (DOS) Cancellations

HARRISBURG, Pa., March 6, 2014 /PRNewswire-USNewswire/ --Ambulatory surgical facilities (ASFs) in northeast Pennsylvania collaborated with the Pennsylvania Patient Safety Authority and implemented protocols, like a nurse-driven preoperative screening and assessment, for reducing day-of-surgery (DOS) cancellations, according to an article from the March Pennsylvania Patient Safety Advisory released today. 

A nurse-driven preoperative screening and assessment is a separate clinical evaluation for patients undergoing same-day surgery. This evaluation of the patient's history and physical, diagnostic tests and psychosocial information is used to identify the patient's medical, physical and psychosocial needs and risks for developing complications or requiring cancellation of same-day surgery.

"Ambulatory surgical facilities are not required to use nurse-driven preoperative screenings and assessments, however our collaboration shows that by implementing them and some other protocols day-of-surgery cancellations can be reduced," Lea Anne Gardner, PhD, RN, senior patient safety analyst for the Pennsylvania Patient Safety Authority said. "A standardized checklist and initiating a second preoperative patient phone call were some other helpful interventions used during the collaboration."

From January 2012 through June 2013, the Authority conducted an 18-month collaborative improvement project with 11 ASFs in the northeast region of Pennsylvania.

"The project focused on day-of-surgery cancellations because preoperative screening on the day-of-surgery is the last opportunity to catch medical conditions that would place patients at risk for complication and rearranging schedules due to last-minute cancellations which creates opportunities for mix-ups with patient names, procedures or medications," Gardner said. "The goal of this collaboration was to reduce patient day-of-surgery cancellations by 30 percent and transfers to acute care hospitals by 25 percent."

The collaboration had three phases: the planning phase (January 6, 2012 through June 30, 2012) focused on standardizing definitions for cancellations and transfers; the preintervention phase (July 1, 2012 through November 30, 2012) where facilities implemented the cancellation and transfer event investigation forms; and the postintervention phase (December 1, 2012 through June 30, 2013) which began with implementation of the standardized preoperative checklist.

During the last phase two additional interventions were introduced to the ASFs: 1) initiating a second patient preoperative phone call and incorporating health literacy strategies into patient-staff interactions (e.g., teach-back method, phrasing of questions) and patient-friendly preoperative forms. A third intervention, done by the Authority, was a health literacy conference call which gave ASFs strategies to avoid miscommunication and confusion with the patient by not using medical jargon etc.

"No-show cancellation rates were 120 percent higher in patients who did not have a preoperative screening and assessment done compared to patients who were screened preoperatively during the postintervention period," Gardner said. "Transportation-related and protocol-related day-of-surgery cancellations decreased by 28.5 percent and 22.4 percent, respectively, in patients who received a preoperative screening and assessment using a standardized checklist."

A DOS cancellation was defined as a cancellation of a scheduled procedure or surgery that occurred after 12:01 a.m. on the DOS for any reason. DOS cancellations occurred prior to admission, after admission and after anesthesia.

The ASFs achieved a 9.7 percent reduction in their DOS cancellation rate, from 29.6 DOS cancellations per 1,000 completed procedures preintervention to 26.8 DOS cancellations per 1,000 completed procedures postintervention.

Gardner said a closer look at patients without a preoperative screening showed a greater percentage of no-show cancellations.

"No shows on the day-of-surgery drop 10 to 15 percent if a preoperative screening and assessment is performed. That number increases 30 to 50 percent if a preoperative screening and assessment is not done prior to the day of surgery," Gardner added. "Selecting appropriate patients for same-day-surgery through the implementation of these interventions can improve patient safety by identifying patients suited for outpatient surgery or procedures, reduce disruptions or delays in the surgery schedule and increase patient accountability."

For more information about the ASF collaboration go to the March Pennsylvania Patient Safety Advisory article, "Preoperative Screening and the Influence on Cancellations and Transfers: An Ambulatory Surgical Facility Collaboration" at www.patientsafetyauthority.org. The interventions used during the collaborative are also available on the Authority's website under "educational tools."

The Authority's 2014 March Advisory contains other clinical articles with toolkits for the healthcare provider to improve patient safety. This year marks the 10^th Anniversary since the first Patient Safety Advisory was published in March 2003 during Patient Safety Awareness Week. Highlights of the 2014 March Advisory include:

• Aligning the Lines: An Analysis of IV Line Errors: Analysis of intravenous (IV) line events reported to the Authority showed that three errors were responsible for nearly 50 percent of the events: rate of infusion mix-up or line mix-up, IV lines not attached to patients and errors associated with piggyback infusions. Included with this article are risk reduction strategies and self-assessment questions, the latter for internal education.

• The Use of Patient Sitters to Reduce Falls: Best Practices: Based on data from 75 hospitals participating in the Pennsylvania Hospital Engagement Network Falls Reduction and Prevention Collaboration, a higher percentage of assisted falls and a lower rate of falls with harm may be associated with the use of sitters. Authority analysts identify specific sitter program design elements that have the potential to reduce rates of falls with harm.   

• Improvement of Pennsylvania Healthcare Consumers' Awareness of Patient Safety: In 2013, 604 randomly selected participants were surveyed about their respective engagement in 10 consumer patient safety practices. Results indicate that the patient safety movement in Pennsylvania is raising awareness of patient safety among healthcare consumers in the commonwealth. Participants were more inclined toward asking for an explanation for understanding, questioning unfamiliar drugs or reasons for procedures, and seeking second opinions about healthcare, and participants were least inclined toward asking about handwashing.

• Commitment to Patient Safety Recognized in Pennsylvania: The Pennsylvania Patient Safety Authority held its inaugural "I Am Patient Safety" poster contest during the last few months to highlight individuals and groups with Pennsylvania's healthcare facilities who have made a personal commitment to patient safety. This article highlights those individuals and groups featured on posters this year in conjunction with National Patient Safety Awareness Week.

• Wrong-Site Surgery Update: Ten wrong-site procedures were reported in Pennsylvania operating suites for the quarter of October through December 2013. Near-miss reports continue to demonstrate both areas of continued weakness and the effectiveness of the evidence-based best practices to prevent wrong-site surgery.

For the complete 2014 March Pennsylvania Patient Safety Advisory, go to www.patientsafetyauthority.org.

SOURCE Pennsylvania Patient Safety Authority